Ms Desiree Yen1, Allison Tan1, Pamela Partana1, Wei Ching Tan1, Devendra Kanagalingam1, Liying Yang1
1Singapore General Hospital, Singapore
Biography:
Centre for High Risk Pregnancy, Department of Obstetrics and Gynaecology
Abstract:
Acute Severe Ulcerative Colitis (ASUC) during pregnancy presents significant management challenges and necessitates complex decision-making. This case study chronicles the clinical journey of a 33-year-old woman, gravida 2 para 1, with a background history of rheumatoid arthritis and inflammatory bowel disease, diagnosed on colonoscopy five years prior. The patient had defaulted on follow-up visits due to being asymptomatic until this pregnancy. Her previous pregnancy, 2 years prior to this index pregnancy was uneventful, apart from a caesarean delivery at 39 weeks for non-reassuring fetal status.
At 10 weeks gestation, she presented to our hospital with pyrexia, abdominal pain, bloody diarrhoea, and generalised inflammatory skin lesions. A sigmoidoscopy confirmed UC flare, showing extensive circumferential colitis with exudates and deep ulcers. The skin lesion were identified as neutrophilic dermatosis, a rare extraintestinal manifestation of UC. Despite treatment with mesalazine, steroids, and infliximab, her symptoms persisted and inflammatory markers remained elevated, prompting further investigation. A subsequent colonoscopy confirmed CMV colitis and she was started on Valganciclovir. Avidity test showed that this is likely to be a case of CMV reactivation and the couple was counselled about the risk of vertical transmission, fetal CMV infection, and its sequalae. They opted against prenatal CMV testing.
At 16 weeks gestation, the patient developed acute abdominal pain, necessitating emergency subtotal colectomy and creation of ileostomy. Postoperatively, she remained stable with no further flares throughout the rest of the antenatal period. She ultimately had a successful vaginal birth after caesarean section at 40+1 weeks gestation. The baby was healthy, weighing 3295 grams, with no CMV detected in urinary testing. After delivery, she remained well and underwent completion proctectomy with creation of ileal pouch anal anastomosis at seven months postpartum.
This case underscores the critical importance of timely diagnosis, aggressive treatment, and multidisciplinary collaboration in managing ASUC during pregnancy.
Keywords
Ulcerative Colitis, Pregnancy, CMV colitis, acute severe ulcerative colitis, colectomy
References
1. https://casereports.bmj.com/content/2018/bcr-2017-223540.short
2. https://fg.bmj.com/content/12/3/182.abstract